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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Seventy-four patients with chest pain and no prior history of organic heart disease were interviewed with a structured psychiatric interview immediately after coronary arteriography. The majority of patients with both negative and positive coronary angiographies had undergone previous exercise tolerance tests, but the patients with angiographic coronary artery disease were significantly more likely to have had positive results on a treadmill test. Patients with chest pain and negative coronary arteriograms were significantly younger; more likely to be female; more apt to have a higher number of autonomic symptoms (tachycardia, dyspnea, dizziness, and paresthesias) associated with chest pain, and more likely to describe atypical chest pain. Patients with chest pain and normal coronary arteriographic results also had significantly higher psychologic scores on indices of anxiety and depression and were significantly more likely to meet criteria of the Diagnostic and Statistical Manual of Mental Disorders, third edition, for panic disorder (43 percent versus 6.5 percent), major depression (36 percent versus 4 percent), and two or more phobias (36 percent versus 15 percent) than were patients with chest pain and a coronary arteriography study demonstrating coronary artery stenosis.
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PMID:Chest pain: relationship of psychiatric illness to coronary arteriographic results. 333 15

The combination of nifedipine and atenolol must be evaluated in terms of risks and benefits to the hypertensive patient. Disadvantages with single-agent therapy justify trials of combination regimens. beta-Blockers may be unacceptable to some patients because of gastrointestinal upset, musculoskeletal symptoms, tiredness, malaise, insomnia, depression or confusion, sweating, breathlessness or cold extremities. The side effect profile varies from patient to patient and between different beta-blockers. Calcium antagonists also have characteristic side effects, including severe headaches, flushing and oedema, tachycardia and possibly worrying palpitations, and polyuria. Combining a calcium antagonist and a beta-blocker can reduce some side effects; for example, tachycardia is offset by addition of beta-blocker to calcium antagonist therapy, and beta-blocker-induced cold extremities may be reversed with a drug such as nifedipine. Moreover, the antihypertensive efficacy is increased, which is useful in previously resistant patients. However, an excessive fall in blood pressure is a possible adverse effect of the combination. There is also the possibility of precipitating heart failure in patients with cardiomegaly and severely compromised left ventricular function. The combination of nifedipine and atenolol was evaluated in 25 patients in a randomised, crossover trial following a month's treatment with atenolol 50mg twice daily. Patients received either atenolol 50mg twice daily alone, or atenolol 50mg twice daily with sustained release nifedipine 20mg or 40mg twice daily, or placebo twice daily during three 4-week treatment periods. Additional antihypertensive benefit was obtained by addition of the low dose of nifedipine compared with atenolol alone, but no further advantage was obtained with the higher nifedipine dose.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Aims of combination therapy--improved quality of life or better blood pressure control? 337 14

The pathophysiology, clinical features, and management of cyanide toxicity are reviewed and sources of cyanide are listed. Cyanide is a deadly poison that is found in many foods and household and industrial products, including some that are readily available. Cyanide binds with cytochrome oxidase, the enzyme responsible for oxidative phosphorylation, and paralyzes cellular respiration. Because the tissues cannot use oxygen that is delivered, aerobic metabolism ceases. The signs and symptoms of cyanide poisoning reflect the extent of cellular hypoxia. Manifestations may include respiratory abnormalities (progressing from tachypnea and dyspnea to respiratory depression and apnea), hemodynamic instability, metabolic acidosis, and, possibly, local irritant effects after oral ingestion of cyanide. The mainstays of therapy are 100% oxygen and specific antidotes to cyanide. Sequential treatment with amyl nitrite by inhalation, intravenous sodium nitrite 3%, and intravenous sodium thiosulfate 25% is directed toward decreasing the amount of cyanide available for cellular binding. Nitrites convert hemoglobin to methemoglobin, which reacts with cyanide to form cyanomethemoglobin. Sodium thiosulfate serves as a source of sulfur groups, which are needed for conversion of cyanide to thiocyanate, a compound that is relatively less toxic and is excreted renally. Supportive care also is important. Cobalt EDTA, hydroxocobalamin, and aminophenols have also been used but are not considered standard treatments. Cyanide poisoning is a medical emergency that requires prompt recognition and immediate and aggressive treatment.
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PMID:Clinical features and management of cyanide poisoning. 353 Jun 15

The sequential development of the clinical signs and lesions in the organs of Nubian goats fed on Aristolochia bracteata (Um Galagel) and Cadaba rotundifolia (Kurmut) and their mixture in certain proportions was studied. Kidney and liver function was tested and the results correlated with pathological and clinical changes. Diarrhea, dyspnea, tympany, arching of the back, and loss of condition and hair from the back were the prominent signs of Aristolochia poisoning in goats. The main pathological changes were hemorrhages in the lungs, heart and kidneys, fatty change and congestion in the liver, catarrhal abomasitis and enteritis, and straw-colored fluid in serous cavities. An increase in GOT activity and ammonia and urea concentrations, and a decrease in the concentrations of total protein and magnesium were detected in the serum of Aristolochia-poisoned goats. The clinical signs in goats fed with C rotundifolia were pronounced depression, diarrhea, frothing at the mouth, dyspnea, ataxia, loss of condition and recumbency. The lesions consisted of diffuse hemorrhage in the abomasum, heart and lungs, catarrhal enteritis, erosions on the intestinal mucous membrane, degeneration and/or necrosis of the cells of the renal tubules, and fatty change and necrosis in the liver. These changes were correlated with those in the serum constituents and blood cells. The effects of A bracteata and C rotundifolia were additive in goats.
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PMID:The combined toxicity of Aristolochia bracteata and Cadaba rotundifolia to goats. 357 45

Ventricular preexcitation, as seen in Wolff-Parkinson-White syndrome, results in a high frequency of positive exercise electrocardiographic responses. Why this occurs is unknown but is not believed to reflect myocardial ischemia. Exercise thallium testing is often used for noninvasive assessment of coronary artery disease in patients with conditions known to result in false-positive electrocardiographic responses. To assess the effects of ventricular preexcitation on exercise thallium testing, 8 men (aged 42 +/- 4 years) with this finding were studied. No subject had signs or symptoms of coronary artery disease. Subjects exercised on a bicycle ergometer to a double product of 26,000 +/- 2,000 (+/- standard error of mean). All but one of the subjects had at least 1 mm of ST-segment depression. Tests were terminated because of fatigue or dyspnea and no patient had chest pain. Thallium test results were abnormal in 5 patients, 2 of whom had stress defects as well as abnormally delayed thallium washout. One of these subjects had normal coronary arteries on angiography with a negative ergonovine challenge, and both had normal exercise radionuclide ventriculographic studies. Delayed thallium washout was noted in 3 of the subjects with ventricular preexcitation and normal stress images. This study suggests that exercise thallium testing is frequently abnormal in subjects with ventricular preexcitation. Ventricular preexcitation may cause dyssynergy of ventricular activation, which could alter myocardial thallium handling, much as occurs with left bundle branch block. Exercise radionuclide ventriculography may be a better test for noninvasive assessment of coronary artery disease in patients with ventricular preexcitation.
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PMID:Exercise thallium testing in ventricular preexcitation. 357 50

Acute selenium (Se) toxicosis was evaluated in 20 female crossbred sheep, 8 to 14 mo of age. Five groups of 4 sheep each were given 0.4, 0.6, 0.7, 0.8, or 1.0 mg Se/kg body weight IM. The LD50 for sodium selenite was 0.7 mg Se/kg body weight with a standard error of 0.035 over a 192 hr observation period. The most evident clinical signs were dyspnea and depression. At necropsy, the most consistent lesions in animals which received 0.7, 0.8, and 1.0 mg Se/kg body weight were edematous lungs and pale mottled hearts. Highest tissue Se concentrations in declining order were found in the liver, kidney and heart.
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PMID:Acute selenium toxicosis in sheep. 360 43

The purpose of this study is to compare the psychosomatic symptoms of postmenopausal women who are users of hormonal treatment with the psychosomatic symptoms of nonusers. We studied 68 postmenopausal women receiving estrogen treatment (age range 48-56 years; 51.1 +/- 1.9, mean +/- SD) and 50 postmenopausal women (age range 45-55 years; 50.7 +/- 2.5) as controls. The symptoms we studied were: (1) nightly perspiration; (2) vasomotor flushes; (3) dyspnea; (4) vertigo; (5) headache; (6) disturbance of libido; (7) depression, and (8) anxiety. We found a beneficial effect of estrogen treatment in nightly perspiration (p less than 0.01), vasomotor flushes (p less than 0.001) and disturbance of libido (p less than 0.01). We found no difference between the two groups in dyspnea, vertigo, headache, depression and anxiety. Our findings show that with hormonal treatment in postmenopausal women there is a beneficial effect in only some psychosomatic symptoms.
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PMID:Psychosomatic symptoms of postmenopausal women with or without hormonal treatment. 362 80

The clinical signs and lesions of Nubian goats and Desert sheep orally dosed with fresh and dry leaves and stems of Ipomoea carnea at 2.5, 5 and 10 g/kg/day were studied. The signs of Ipomoea poisoning were inappetence, depression, weakness of the hind limbs, dyspnea, staggering, and pallor of the visible mucous membranes. The main lesions were focal necrosis and fatty vacuolation of centrilobular hepatocytes, accumulation of fibroblasts in hepatic portal tracts, degeneration or necrosis of the cells of the renal proximal convoluted tubules, hemorrhage in renal cortices, in renal medullas and in cardiac muscle fibers, focal pulmonary edema, and emphysema and straw-colored fluid in serous cavities. Increased serum aspartate amino transferase and ammonia concentrations, and decreased concentrations of total protein, calcium and magnesium in the serum of Ipomoea-poisoned animals were detected. Hematological changes indicated the development of normocytic normochromic anaemia.
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PMID:The effects of Ipomoea carnea on goats and sheep. 362 12

One hundred patients with chronic airflow limitation (CAL) randomly selected from over 600 such patients seen in the previous 2 years at a respiratory referral centre were asked about the ways in which their lives were adversely effected by their lung problems. Major problem areas included dyspnoea on day-to-day activities, fatigue and certain areas of emotional function including embarrassment, depression, anxiety and frustration. Severity of airflow limitation was only weakly related to patients' problems. Patients did not volunteer items easily, and most problems were elicited by specific probes. In 36 subjects, relatives were asked about the patients' problems. Relatives tended to identify fewer items, but items identified were judged more important; there was a limited relation between spouses' and patients' assessment of CAL-related problems (Pearson's r = 0.42-0.60). These results suggest that physicians cannot rely on severity of airflow limitation as an indicator of the impact of CAL on patients' lives. Patients should be specifically asked about problem areas, especially emotional difficulties, and spouses' view of the problems should be obtained.
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PMID:Quality of life in patients with chronic airflow limitation. 366 90

Findings from natural cases and experiments with cattle emphasise that flowering plants are the most important form of Bryophyllum (Kalanchoe) spp in poisonings in Australia. The main life-threatening lesion is myocardial. The effects on the alimentary tract are less important than was believed previously. B. tubiflorum, B. daigremontianum x B. tubiflorum, B. pinnatum and B. proliferum caused 41 recorded poisoning incidents affecting 379 cattle in Queensland between 1960 and 1984. Poisoning occurred between May and October--the flowering season of these plants. Experimental B. tubiflorum poisoning and natural poisonings produced anorexia, depression, ruminal atony, diarrhoea, heart rate and rhythm abnormalities, dyspnoea and death. Increased plasma concentrations of urea, creatinine and glucose and decreased chloride were measured experimentally. Both natural and experimental cases had myocardial degeneration and necrosis with haemorrhages of the heart and alimentary tract. Cattle with severe dyspnoea had atelectasis and emphysema of the lungs. Some cattle had mild nephrosis. The median lethal doses of B. tubiflorum flowers, roots and leaf plus stem were 0.7, 2.3 and 5.0 g dry matter/kg liveweight respectively (7, 7 and 40 g wet weight/kg). Bufadienolides have been isolated recently from B. tubiflorum flowers and the syndrome is consistent with cardiac glycoside poisoning.
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PMID:Hearts and flowers: Bryophyllum poisoning of cattle. 377 71


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